Good question! When you figure out what exactly is "normal," let us know. For now, the important question to ask yourself is: what is normal for my mom? Unless your mother experienced the same dizziness and stomach upset prior to her fall, there is reason to see a doctor. Falls are the leading cause of brain injury in older adults. Sometimes seemingly mild head bumps can result in problems like those you describe. Bottom line: see a neurologist for an evaluation of the brain (e.g., CT Scan, MRI), and consider seeing a neuropsychologist for an evaluation of cognitive and behavioral functioning.

The bump and sensitivity could be skin problems (i.e., bruising from the impact) or they could indicate deeper problems; the dizziness and vision disturbance are warning signs. Read on....

Many people who sustain head injuries are seen in the Emergency Room and released, not admitted to the hospital. At the time of the injury, you may have been unconscious for an indeterminate period of time, dazed, dizzy or confused. You may have gone to the Emergency Room, been examined by a doctor, given a CT scan (Computerized Tomography), and been told that you were well enough to go home. If you felt fine, you went on your way. For most people who sustain a mild, closed head injury, the above scenario is typical. Most mildly injured people experience no further problems. However, some people who sustain mild HEAD injuries also sustain mild BRAIN injury. This occurs when the brain bounces around inside the brain; nerves in the brain may be stretched and broken, brain tissue may be bruised and broken by impacting the bony skull. It is very difficult to tell if an Emergency Room patient with a mild head injury has sustained BRAIN injury. Believe it or not, CT scans often DO NOT detect mild brain injuries.

How do you know if you are going home with a brain injury? First, look for the following problems in the first 24 hours after the injury; contact your doctor if you experience any:

1. Weakness in one arm or leg.
2. Vomiting more than once.
3. Continuing or worsening headache.
4. Neck stiffness or pain.
5. Unequal pupil size.
6. Vision changes (e.g. seeing double).
7. Clear or bloody drainage from the ear.
8. Convulsions ("fits" or seizures).
9. Difficulty swallowing or speaking.
10. Difficulty in arousing or waking.
11. Loss of consciousness.
12. Confusion.
13. Failure to improve.

In children, also look for:

1. Restless or fussy.
2. Cannot pay attention.
3. Forgetful.
4. Difficulty learning.
5. Lethargic (takes longer to do things).
6. Tires easily or wants to sleep extra.
7. Does not act the same; personality or mood changes.
8. Easily upset or loses temper a lot.
9. Impulsive; acts before thinking.
10. Drops things a lot.

It can take several hours up to several weeks for problems to resolve, so if you experience any of the above symptoms at any time after the injury, consult your physician. A simplified way to determine whether a head injury may have caused a brain injury requiring further attention is to consider whether you or your child are behaving differently since the accident. The change may be so subtle that you cannot specifically identify the problem, but if you just know that "something is wrong, something is different" then further attention may be warranted. While most MILD BRAIN injuries do resolve, some people experience problems for up to a year or more. Some people with mild brain injuries experience difficulties for an indefinite period of time. Long-term effects of mild brain injury include memory loss, difficulty learning, fatigue, head or neck pain, sleep changes, difficulty focusing attention, depression, and other changes. There is help available for people who have long-term problems after a mild brain injury; contact your state Brain Injury Association or your physician for advice and consider seeing a neuropsychologist for assessment and treatment recommendations (see FAQ's for more on neuropsychology).

References: (1) "Head Injury Precautions." The Emergency & Trauma Center, Fairfax Hospital, Virginia. (2) "Head Injury." Sentara Hospitals, Virginia. (3) "When Your Child Goes Home After Being Examined For Head Injury In An Emergency Department." Research and Training Center, New England Medical Center, Boston, MA.

What don’t you believe? If you’re still having symptoms after 2 ½ years, your physicians are probably right in telling you that you’re likely to have permanent effects of the injury. Getting back to "just the way you were" before the injury is very unlikely. You might continue to see improvements, but after that long post-injury, the improvements are likely to be slow and gradual. If you don’t believe your physicians are exploring all the options, by all means get a second opinion. It never hurts to consult another expert. (Well, it might hurt your wallet if your insurance won’t pay for it.) You might want to consider a specialist in pain management. If you haven’t already done so, consider a neuropsychological evaluation to explore your strengths and weaknesses. Being an accountant is probably one of the most difficult things for a person with brain injury to attempt. It’s a job that requires a good memory, good math skills, sustained attention, organization, stamina and the ability to attend to details. However, if your symptoms are primarily sensitivity to light and sound and balance, maybe the skills you need for accounting are strong enough for you to return to it as a career. If your skills won’t allow you go back to accounting, consult with a vocational rehabilitation expert or consider career counseling to look for options that will fit with your abilities and interests. Only by knowing your strengths and weaknesses and being realistic will you be able to make an informed decision about your future.

It is very likely brain related. Although less common than many symptoms of brain injury such as memory problems or headaches, many persons with brain injury do report altered taste and smell. It also can occur with some forms of brain tumor or after brain surgery. As for how long it will last - it could get better gradually, or it could take longer or even be permanent. Like many things with brain injury, the rate and amount of recovery vary greatly. I know that doesn’t help much, but your physicians are really the only ones who can give you specific information about your prognosis. You might consider seeing a nutritionist if your weight loss continues. You need to maintain a certain caloric intake and balance of nutrients to be healthy. If eating is difficult, it will be important to make sure you are eating the right things to maintain your health. You may also consider eating foods with mild taste and smell. (Stay away from that Limburger cheese!)

Pat certainly hasn’t encountered this symptom before! It’s probably impossible to know for sure what’s causing it. It’s possible that he is experiencing a mild hallucination (probably on a par with hearing someone call your name when no one is there). It could also be that his injury has triggered an association with the part of his brain responsible for storing "cigarette smell" in his memory. Perhaps there is an odor in the environment that his nose detects, but his brain mislabels as "cigarette smoke." Sometimes patient who experience seizures smell an odor before a seizure (although you don’t mention seizures). Pat’s open to other explanations if someone can suggest one.

This problem could actually be serious if your husband believes there is a fire in the home – or conversely if he fails to respond to a smell of smoke because he believes it is just "in his head." You may want to check the smoke detectors in your home to be sure they are working – just in case! Unfortunately, I’m unaware of any specific treatments other than to wait and see if this is a temporary symptom.